New York — With very weak health systems and overall capacity constraints to effectively respond to the deadly coronavirus disease, Africa's fate against the invisible enemy, was going to be nothing short of catastrophic according to early predictions. Although Africa is yet to reach its peak, many countries are not seeing the exponential growth in case numbers, or in mortality rates as seen in other regions of the world. So far, the continent has the lowest mortality rates with higher recovery rates globally.
The slower than normal onset gives reason for some cautious optimism for Africa to weather this storm. What is working in Africa's favor? Three key factors in our view which provide important lessons for the future.
Africa's aggressive response:
First, is the swift and what seemed like an aggressive response to the pandemic by Africa as a whole. The continent reacted aggressively and proactively to COVID-19 as a preventative measure. By April 5, many African countries had imposed either localized, partial or full lockdowns of their countries, economies, schools, borders and large gatherings in an effort to contain the disease. Many of these measures were implemented long before any significant number of cases were recorded on the continent.
For a region that had only 99 confirmed cases by March 20, the above measures seemed extreme. Looking back, this was a bold response and rightly so. Stopping and containing the virus was not only a first line of defense for most, it constituted the main strategy between life and death given already overwhelmed and incapacitated health systems that have long struggled with responding to non-emergency cases. Such wholesale lockdown measures were complemented by community responses which for the African context have long proven to be effective in responding to similar disease outbreaks. The aggressive measures might be paying off.
Favourable population structure:
Africa's demographic structure might be one of its mitigating features against Covid-19. The continent remains the most youthful globally, with more than 60.0 per cent of its population below the age of 25 compared to around 42.0 per cent globally. This trend is in stark contrast to developed regions where the proportion of aging populations are higher. The Covid-19 battle may be half won therefore given the continent's demographic structure.
Available evidence corroborates with high risk population groups above, with age accounting for more deaths, without discounting other factors. In China, Europe and America for example more than 80% of Covid-19 related deaths are among the 65 years and above age group. All countries that have had the highest record of deaths are amongst the top ten countries with the largest share towards aging populations globally. Europe, America, and China have aging populations of about 20%, 16% and 12% respectively compared to less than 5% in Africa.
Similar trends are observed in Africa with age accounting for most deaths in the 55 years and above age bracket. Granted, a much lower threshold than in developed regions but this is against a backdrop of low life expectancy pegged at 61 years for Sub Saharan Africa. Interestingly, countries that have higher proportions of adults over 65 years in Africa such as Tunisia (8%), Morocco (7.1%); Algeria (6.2%), South Africa (6%) and Egypt (5%) - account for up to two thirds of all Covid related deaths. This is quite instructive.
Exposure to a wide range of treatment regiments:
The continent shoulders the highest disease burden, with HIV, malaria and diarrhea amongst its top five killers. There were 25.7 million people living with HIV/AIDS and a little over 90% of those affected on antiretroviral drugs in 2018. Malaria is widespread just like the use Bacillus Calmette-Guérin (BCG) vaccinations which are believed to offer broad protection against respiratory infections. What is less known however, is the interaction between the prevalence of other diseases on the continent, related treatments and SAR-Covid-2. The question remains, whether the combined treatments for all these diseases are contributing to the high recovery rates and relatively low Covid deaths in Africa.
In Senegal and Madagascar for example, COVID-19 patients on hydroxychloroquine and the herbal remedy Artemisia annua have been observed to recover faster from the disease with lower deaths. In both countries, even with rising cases, recovery rates from Covid19 are much higher - consistent with the observations in most malaria prone countries. Interestingly, malaria is not prevalent in Africa's Covid-19 hotspots of South Africa and North Africa.
The fact that the World Health Organization (WHO) is conducting clinical trials on malaria drugs (chloroquine/hydroxychloroquine); HIV drugs (remdesivir, ritonavir/lopinavir and interferon-beta) is quite telling and holds a promise for the continent where the use of these drugs is already widespread. The jury is still out on this one.
A Reason for Hope:
The African story is yet to fully unfold. For now, caution needs to be applied even with the pressure to lift restrictions to avoid the socioeconomic fallout. How countries will emerge from this crisis will be important. Any missteps can easily tip the scales towards disaster if the theories above do not hold. Maintaining some of the measures that have proven effective, ramping up experimentation with existing and herbal remedies combined with an innovation drive will certainly help the African case. From Senegal's affordable rapid testing kits and low-cost ventilator substitution; Ghana's innovation pooling test, Ethiopia's contactless soap dispensers, mobile tech solutions in Nigeria, Uganda and Rwanda as well as the repurposing of industries to respond to the pandemic is deeply encouraging. The odds may be against the continent, but there is reason for hope.